Intro:
Welcome to the NSPCC Learning Podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.
Producer:
Welcome to the NSPCC learning Podcast. This episode of the podcast, recorded in January 2024, is all about pre-birth assessments. Assessments help health professionals to identify strengths, needs, risks and protective factors in the lives of expectant families.
You'll hear from Sophie Bell, the associate head of development at the NSPCC, in conversation with Anna Squirrel and Nina Bell, social work professionals working in Blackburn with Darwen. The panel will be discussing what good pre-birth assessments look like, what social workers need to think about when conducting a pre-birth assessment, and how the NSPCC's pre-birth assessment tool, Graded Care Profile 2 Antenatal, can be used to support expectant parents.
Sophie Bell:
I'm Sophie Bell. I'm the associate head of development at the NSPCC, and I'm responsible for our early years portfolio, which includes the Graded Care Antenatal assessment. And thank you, Anna and Nina, for joining us today. Anna, can I hand over to you to introduce yourself?
Anna Squirrell:
Hi, I'm Anna Squirrell, I'm the team leader in the pre-birth team in Blackburn with Darwen.
Sophie:
Nina.
Nina Bell:
Hi. I'm Nina Bell, advanced practitioner here at safeguarding support team at Blackburn with Darwen.
Sophie:
Brilliant. Thank you both very, very much for joining us today. So, we're here to talk about pre-birth assessments. So the first thing we're going to talk about is: what is a pre-birth assessment?
Nina:
So the pre-birth assessment is like any child and family assessment. We're looking at strengths. We're looking at risk. and within that assessment I split up to different parts. So we look at the unborn baby, health, development. We look at environmental factors and what that family's history is. And we also look at identifying the risks and what's going on for parents.
Sophie:
And in what types of situations might a pre-birth assessment be needed?
Nina:
It can be many situations. It may be that siblings of the unborn baby are already open to us. So we would consider the unborn baby in that family assessment. Equally, we may have parents who have sadly had children removed previously. When they do become pregnant, referrals are then completed by midwifery confirming the pregnancy and need for a pre-birth assessment. There also could be many difficulties, parents and families that can equally self-refer to us as a service, for additional support as well.
Sophie:
And just as an additional question: at what time frames do you do pre-birth assessments? What time frame within the pregnancy would you do a pre-birth assessment? Does it vary, or is there a particular set time frame.
Nina:
That's certainly changed over the last few years. We used to have to wait until the pregnancy was confirmed at least at week 12. However, we are working as soon as we, you know, the booking an appointment has been completed, and that allows additional relationship building. It allows for work to start sooner and certainly when we're using the Graded Care Profile, as soon as we start and use that tool, we're able to review that as part, you know, throughout the pregnancy as well. So, we've got that time to do that intervention with families.
Sophie:
Because I think — I know we can we're going to come on to talking about challenges later on — but I think one of the key challenges that we faced for a long, long time is that, because pregnancy is such a time-limited period, how do we get that intervention done? So assessments themselves take time because you identified the need to build relationships with people. And that's really important. And then by the time that assessment is completed, there's often very little time left to do that intervention and get the parents in the right place, isn't there, for the baby to have the best start in life. So that's really great to hear that things are starting earlier now, to allow that additional time.
Nina:
And just to add to that, Sophie, I know, as part Blackburn with Darwen and the born into care research, a big part of that is for parents to understand what their child's plans are going to be by at least week 30. Pregnancy is stressful enough as it already is, and not knowing what the outcome is going to be, it's extremely traumatic and stressful. So the sooner parents are able to know what that outcome of that assessment is going to be, the sooner the better.
Sophie:
Absolutely. And if they don't know the outcome and they're left with that unknown and that stress, actually that can just add to a parent's level of difficulty in terms of thinking about how overloaded they feel. And we know that parents who are overloaded struggle more emotionally to connect with their children. And even thinking about bonding before birth and that bond with their unborn baby, that actually, if they don't know the outcome and the plan for the baby, it's much more difficult for them to bond with that baby. What types of risks and protective factors do you need to think about when conducting a pre-birth assessment?
Anna:
Okay, so the protective factors we're looking for is what family support they have from the extended family, friends and network around them. We try and make sure that every family that is referred to us they have a family group conference, where all the family to sit around and we all try and decide what support they can offer for the family. We ask if the pregnancy is planned. Through the work that we do, we observe if the parents are showing that attachment to their unborn baby.
We also complete the ACE inquiry, which is the adverse childhood inquiry, early on in our involvement and support parents to access counselling for any trauma that they've experienced in their own childhood, which is really important. And the risk factors include substance misuse, Mental health that's not being managed, domestic abuse between parents and ongoing parental conflict, and also parents who have been previously separated from the children and have been through the court proceedings. They're really our risk factors that we are looking for.
Sophie:
You touched upon the impact of trauma there Anna, and I think we know that lots of families come to the attention of services because of their previous childhood trauma, because of their previous trauma that sometimes occurred in adulthood as well.
Anna:
Yeah.
Sophie:
And actually pregnancy is a real opportune time for them to be able to engage in some interventions, isn't it, because it's before the baby's here and present and has those quite demanding physical needs of looking after a baby? That's very intensive, and parents are often so tired that are they in a position to really engage in some therapeutic counselling that might be needed for that trauma. So, actually thinking about that during pregnancy is such a strength, isn't it, to be able to to offer those parents that chance to overcome some of those issues that may or may not impact on their ability to be the best parent to their baby. And thinking about some of the risk factors: are you able to signpost on to interventions through recognising those risk factors?
Anna:
Yeah. We've got a really good relationship with our colleagues and we've got services like the Wish Centre that we can refer families on to if we're concerned regarding domestic abuse. We've got the Caring Dads programme, which is a brilliant programme for dads where there has been domestic abuse that they can be referred onto. And we've got really good relationships with our mental health services, to support families accessing that help that they need at the earliest opportunity. And we work alongside perinatal as well. So we support, you know, with parents getting that early help at the right time for them through the pregnancy.
Sophie:
And domestic abuse is something that very often begins during pregnancy. So, actually, going back to that relationship building that we talked about earlier, it's such a difficult thing to disclose because it's such a huge safety issue and there's so much stigma around, people experiencing domestic abuse that to be able to recognise it and have people talk to us as professionals about "this is something I'm experiencing in my relationship", is such a strength as well for you to then have services that you can signpost on to. Because we know that all children who experience domestic abuse, regardless of their age, are impacted by it.
And thinking about during pregnancy, the impact of living with domestic abuse as the physical risk, if some of the physical domestic abuse is targeted at the abdomen area, but also just the stress of living with domestic abuse for the expectant parent and the changes in the cortisol levels that that baby would then directly experience, is quite significant as well. What challenges can present themselves when conducting a pre-birth assessment?
Anna:
Well, myself and Nina were just talking about this earlier. And we were saying we're really lucky in Blackburn with Darwen that we rarely have parents who don't consent to the offer offered by our specialist team. However, if parents have been previously open themselves as a child, maybe to children's social care, or they've been through proceedings themselves, then they can often be apprehensive about working with children's social care again. But in Blackburn with Darwen we're working in a systemic way. So, we very much build on our relationships with our families, which is around trust and transparency and good communication.
And like Nina said earlier, we want to make sure that parents are fully informed of the plan the whole way through. And that's what we like about the Graded Care, because while we're doing it, we're doing it alongside parents. We're not doing it to them, we're doing it with them. And we're looking all the way through that it's a strength based tool. We want to help. You want to know where you need that help and where your strengths are, and if there are any areas where you need that specific help, we can get that help for you in the right time and review it and see the progress that you've made.
Sophie:
So Graded Care Antenatal, or GCP2A as we call it for short, is a tool designed to help professionals working with expectant parents to identify areas of strength and areas where they may benefit from support within their assessments.
The tool's split into three different sections, so sections one and two focus on the antenatal period, while section three looks at the early postnatal period; so from birth up to three months old. Section one is designed to be used at the earliest point in pregnancy when the expectant parent comes into contact with services, but it can be completed later on if concerns don't arise until further down the line. Section two is completed when the areas of vulnerability or concern have been identified in section one.
The tool includes areas of known risks that are linked to safeguarding concerns in babies, so it will help professionals to build a picture to identify where concerns emerge in relation to the impact on the developing baby. And it can also be used as an indicator for potential safeguarding concerns after birth within section three. Each of the three sections uses a grading scale of one to five, where one indicates no concerns and five indicates high concerns.
So, how can GCP2A help when conducting a pre-birth assessment?
Nina:
So I know, particularly with the Graded Care Profile, one thing that we have missed for a long time is tools to assist us in looking at identifying strengths, risks and doing that work with families. So, particularly visual tools as well, for families that may have cognitive issues, may struggle with reading and writing. So the Graded Care Profile Antenatal tool really assists a lot of professionals in working with families to understand what we're concerned about.
Anna:
The Graded Care Profile gives us a perfect opportunity to look at the strengths that the family have and their network a support around them, in preparation for the birth of the baby. The Graded Care can give evidence of the current situation for the family. It considers the history, but will look at what's happening here and now for them. For example, are they in a new relationship? Maturity and the support network around them. Have they had support for substance misuse? And through the Graded Care we can evidence that, what's happening now with the family, and we can also look at the risks present in the pregnancy, which helps us make early decisions for the unborn baby if the risks are not being addressed for parents throughout that assessment. So it informs that early decision making for us as well.
Nina:
I just want to add, in terms of — particularly with the Graded Care Profile Antenatal — I like the way we're able to really focus on the family strengths and that family support and wider support network, because I think, particularly for a lot of our families, sadly, some parents are very isolated and do have very limited support networks. And if we can identify that as early as possible as part of relationship building, really supporting parents to access the community, and build those relationships within children's centres and know where to turn to as well.
Sophie:
And I think the other thing that we really try and do through the Graded Care Antenatal is acknowledge that some of those risk factors aren't necessarily within the control of the parents. So things like for families living in poverty who might be living in inadequate housing, actually, we still need to recognise that for the unborn baby and to try and support the parents to have the right housing that's suitable for their baby.
But actually through the Graded Care Antenatal, we're looking very much at that unborn baby's needs and not focusing on who is to blame for this problem. And some of that needs to be unpicked, absolutely, through the wider pre-birth assessment. But it's really just an opportunity for us to highlight where some of the risk areas are and where some of the concerns are, but actually by saying, "and now we need to support you to find the right housing, to be able to access the right benefits" and all of those kinds of things if that's an issue for families. And thinking about my experiences as a practitioner, going out and working with families when that was my role, one of the things that families would often say is "we know there's a problem, we know that things aren't great, but actually we just don't know how to pinpoint those issues." And often it can feel so overwhelming, particularly if you've had services involved before.
And so I think to have a tool which not only helps the families to pinpoint those issues, but also helps them to see that there are strengths as well can be really empowering for families, can't it, and can really support that conversation.
Anna:
It opens up those difficult discussions as well, and the parents are part of that discussion. So there's no surprises along the way with them. They're very much aware of what our concerns are right from the beginning, and we're working towards a goal which is looking at those identified areas and making those improvements. So I agree, it just really does open up those good conversations.
Nina:
Yeah. Just to add to that, I think it allows for a lot of reflection as well. Particularly for parents who have had previous involvement with social care and haven't used this tool with workers before. I think it allows for a lot of reflection and this tool allows that to happen in a less threatening way. I know I've had a lot of parents feedback to me, it's been a really nice experience for them to do it with us because they've always had assessments and work written, you know, about them and never with them. And it is about their life, isn't it? So it's, you know, I think this tool really helps with that.
Sophie:
And I think by having the information laid out in a tool with the different gradings and the fact that it's colour-coded and parents can see, so I might be an amber now and I want to move up to a yellow. The yellow always will tell them what that next step is so they can see then what am I working towards? What's the next step up on that ladder?
So rather than us saying, "actually this is an area of concern, you need to do better." What we're saying is "this is an area of concern, and what we'd like to see is this", which might be a green, but the next step isn't. You know, we don't expect you to get from nought to 100 by next week. But we can see the stepping stones for families to move forward, so that if there is an opportunity within the pregnancy to reassess or regrade the Graded Care Antenatal towards the end of the pregnancy, what we can do then is say, "okay, so we can see that in these areas, things have improved by this much, and what we'd like to see now is this next step."
Anna:
I think it complements the pre-birth work that we do in the team as well, because we get referrals as early as ten, 12 weeks. Nina will know this because obviously we get these referrals through from CADS (children's advice and duty service). And as soon as we get that referral through, we start the programme, which is looking at healthy eating and the importance of antenatal appointments, bonding and attachment with the unborn baby. And so that work really complements the Graded Care as well. So they kind of work aligned with each other, which is really good.
Sophie:
I think one of the challenges I recognise in pre-birth assessments is about that voice of the child and how we can... It's difficult when you've got a baby or a pre-verbal child or a non-verbal child to really include the voice of the child. But actually, when you can't even see that child, that can again be even more difficult to try and, within the assessment, articulate the voice of the child in that lived experience of that unborn baby. Do you have any ways or any tools that you try and bring through the voice of the unborn baby within your pre-birth assessments?
Nina:
I know, particularly for me, I write to the unborn baby as if he or she was, you know, was here. Really talking about what the current worries are, the strengths, what parents are doing to move things along and get the right help. And it seems to bring that unborn baby to life. And, you know, if they were to be born tomorrow, what what their lived experiences be? And I know family support will do that as well on home visit notes, and it does really help bring the unborn baby and that unborn voice to life.
Sophie:
Oh, that sounds fantastic. And I think that's a really nice place to end our discussion. Anna and Nina, thank you for joining me today to talk about early years assessments. If you've listened to this and you want to find out more about the NSPCC's Graded Care Antenatal assessment tool, please visit nspcc.org.uk/GCP2A.
Outro:
Thanks for listening to this NSPCC Learning podcast. At the time of recording, this episode's content was up to date, but the world of safeguarding and child protection is ever-changing. So, if you're looking for the most current safeguarding and child protection training, information or resources, please visit our website for professionals at nspcc.org.uk/learning.
